Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea.
Division of Endocrinology, Department of Internal Medicine, Seoul National University Boramae Medical Center, Seoul, Republic of Korea.
BMC Geriatr. 2021 Dec 7;21(1):684. doi: 10.1186/s12877-021-02629-5.
Although the proportion of older patients with type 2 diabetes mellitus (T2DM) has increased, few studies have reported the factors affecting glucose levels in older patients with long-standing T2DM. This study assessed the determinants of glycemic control in older adults with T2DM of a duration of ≥10 years, including muscle mass, muscle quality, and β-cell function.
This was a prospective study of older patients aged ≥60 years with a T2DM duration of ≥10 years. The Homeostatic Model Assessment of Insulin Resistance (HOMA-IR) index, handgrip strength (HGS), and body composition through bioelectrical impedance analysis were assessed. The primary outcome was a composite of: (i) increment of glycated hemoglobin (HbA1c) from the baseline ≥0.6% and (ii) HbA1c ≥ 9% at any time point during the follow-up period. To find the predicting determinants of the outcome, we performed the Cox proportional hazard analysis.
Among 100 patients (mean age, 64.0 ± 8.6 years; median duration of diabetes, 20 [interquartile range (IQR), 17-23] years; median HbA1c at baseline, 7.1 [IQR, 6.7-7.4] %), the primary outcome was observed in 40 (40.0%) patients during 4.0 (IQR 2.3-5.0) years of follow-up. A Cox proportional hazards model adjusted for age, sex, baseline HbA1c, obesity, duration of DM and anti-diabetic medication at baseline showed that low HGS and insulin resistance at the baseline were independent determinants of the primary outcome (hazard ratio [HR] = 2.23 [95% confidence interval (CI), 1.06-4.72] and 2.39 [95% CI, 1.18-4.83], respectively). Sex stratification confirmed that HGS and muscle mass were independent determinants of the primary outcome only in women (HR per quartile, 0.58 [95% CI, 0.37-0.93] and 0.46 [95% CI, 0.25-0.85], respectively). `.
Low HGS and insulin resistance were independent risk factors for aggravated glycemic control among older patients with long standing T2DM.
尽管 2 型糖尿病（T2DM）老年患者的比例有所增加，但很少有研究报告影响长期 T2DM 老年患者血糖水平的因素。本研究评估了年龄≥60 岁、T2DM 病程≥10 年的老年患者血糖控制的决定因素，包括肌肉量、肌肉质量和β细胞功能。
这是一项前瞻性研究，纳入了年龄≥60 岁、T2DM 病程≥10 年的老年患者。评估了稳态模型评估的胰岛素抵抗（HOMA-IR）指数、握力（HGS）和通过生物电阻抗分析评估的身体成分。主要结局是糖化血红蛋白（HbA1c）从基线升高≥0.6%和（ii）在随访期间的任何时间点 HbA1c≥9%的复合结果。为了找到该结果的预测决定因素，我们进行了 Cox 比例风险分析。
在 100 名患者（平均年龄 64.0±8.6 岁；中位糖尿病病程 20 [四分位距（IQR），17-23]年；基线 HbA1c 中位数 7.1 [IQR，6.7-7.4]%）中，40 名（40.0%）患者在 4.0（IQR 2.3-5.0）年的随访期间出现了主要结局。Cox 比例风险模型调整了年龄、性别、基线 HbA1c、肥胖、糖尿病病程和基线时的抗糖尿病药物，结果显示基线时低握力和胰岛素抵抗是主要结局的独立决定因素（风险比[HR]分别为 2.23[95%可信区间（CI），1.06-4.72]和 2.39[95% CI，1.18-4.83]）。性别分层证实，握力和肌肉质量仅在女性中是主要结局的独立决定因素（每四分位数 HR，0.58[95% CI，0.37-0.93]和 0.46[95% CI，0.25-0.85]）。
低握力和胰岛素抵抗是长期 T2DM 老年患者血糖控制恶化的独立危险因素。
